This dissertation submitted to the University of Dhaka for the degree of Master of Philosophy.

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An analytic type of case-control study was done among rural elderly people aged 60 years and above who had injury due to falls where 137 cases were from NITOR and from DMC as age and sex matched control of 274. It is aimed to determine the risk factors (socio-demographic, behavioral, environmental including morbidity related risk in particular) of elderly falls in rural Bangladesh. Data were collected through convenient sampling technique by face to face interview using a semi-structured questionnaire. To estimate the prevalence of elderly falls in rural areas of Bangladesh a secondary analysis was done on BHIS Survey data which was collected from twelve districts of Bangladesh that had been covering 46157 elderly people. In secondary analysis it was found that the prevalence of elderly fall was 10/1000 population and death due to fall was 1.6/100,000 population, in rural area of Bangladesh. Fall rate was increased by age and it was more in female than in male among all the age group. Death due to fall among female was 1.84/100,000 population which was more than male that was 1.37/100,000 population. In case control study it was found that majority of fall among male caused by accidental fall (46%) and slipping was the second cause whereas in female slipping (16%) was the commonest cause of fall followed by accidental fall (12%). Common place of fall was bathroom in age group of 65-69 years whereas bedroom fall was the most common place for individual above 75year. Strong statistical association was revealed between types of family, physical activities, foot wear, mobility difficulties, extremity disability, limitation of activities, senile cataract, COPD and urinary incontinence. The odds ratios with 95% CI were estimated for joint family (OR= 0.203, CI=0.085 – 0.484), educational level, among physical activity - brisk walking, house work, carrying load were significantly associated with elderly fall which act as protective factors whereas gardening (OR= 1.634, CI= 0.525- 5.083) act as risk factor for elderly fall. Taking medicine (OR= 1.803, CI= 0.801- 4.057), foot wear not properly fitting (OR= 3.655, CI= 3.544 – 9.022) and slick sole (OR=1.944,CI=0.406 – 2.197) were significantly associated with elderly fall. Awareness about fall (OR= 0.210, CI= 0.128 – 0.347) represents a protective factor. Among environmental risk factors, mosaic floor (OR= 1.781, CI =0.584 – 5.792), wet and slippery bathroom, place around tube well that was kaccha (OR= 1.487, CI= 0.636 – 3.476), uneven sidewalk (OR= 1.132, CI=0.368- 3.485) and slippery condition (OR= 3.018, CI= 0.561 – 16.248) are all associate with elderly fall. Among morbidity, mobility difficulties and extremity disability were significantly associated with elderly fall. Three main diseases associated with elderly falls were identified: senile cataract (OR= 1.229, CI=0.083 – 0.633), COPD (OR= 2.423, CI= 1.314- 31.400) and urinary incontinence (OR= 1.903, CI= 0.179 – 4.548). Fall prevention is a challenge to population ageing. The numbers of falls increase in magnitude as the numbers of older adults increase in many nations throughout the world. The information about the elderly falls is lacking in Bangladesh. It is important to estimate the magnitude of the elderly falls to convince policy makers to take necessary measures to address the problem. Determining the risk factors for elderly fall is also important to design appropriate interventions for prevention of elderly falls in Bangladesh.

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en

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University of Dhaka

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dc.title

Magnitude and determinants of elderly falls in a rural community of Bangladesh